The (Costly) Magic of Laser Surgery

Like a magic wand, a laser can smooth out fine lines and acne scars, vaporize birthmarks and moles, and erase those less-than-glamorous sun spots and facial hairs. Spider veins, warts, tattoos -- they all disappear under the high-intensity light of the laser.

If your body has become a fixer-upper, chances are you've investigated lasers -- trendy and well hyped as they are. When it comes to your bod, you want the state of the art.

"Lasers are extraordinarily useful. ... The technology has advanced so that they can target and remove specific colors and structures -- a blood vessel, a pigmented cell, or a layer of [skin] -- and leave everything around it, above it, and below it, totally unaffected," says Kenneth A. Arndt, MD, professor of dermatology at Harvard Medical School.

"There are so many kinds of lasers today. ... They really are like a magic wand to erase the tell-tale signs of time," says Leslie Baumann, MD, director of cosmetic surgery at the University of Miami. "For blood vessels, on the face and elsewhere, the newer lasers don't cause bruising. For pigment problems, there's nothing better."

However, dermatologists caution consumers to keep an open mind when shopping around for a procedure. Lasers are costly -- and may not be the only solution to the problem. "When someone comes to me for a laser consultation, I tell them they don't necessarily need the high technology with the high out-of-pocket expense. In some cases, there's a simpler technique that I can do that very minute, one that's much less expensive," Arndt tells WebMD.

What can you expect from laser treatments, in terms of effectiveness, cost, and recovery time? Here's what the experts say:

Virtually any laser treatment -- except hair removal -- has some "downtime" when you may want to hide from the world, according to Tina S. Alster, MD, a Washington, D.C., dermatologist who literally wrote the book on the subject: The Essential Guide to Cosmetic Laser Surgery.

"Most of the other treatments require at least a couple of days where there may be some bruises, a little bit of redness, and in the worst situations for laser resurfacing [for facial lines and wrinkles] there's a lot of oozing and crusting," she tells WebMD. "The bottom line is, you'll need to be able to take time off work."

"People with lighter skin are easier to treat with lasers, but that does not mean that people with darker skin cannot also be treated," Alster says. "It's just more difficult. They need a dermatologist with a lot of experience treating different colors of skin, different lesions."

Also, you've got to agree to forgo sun tanning afterward, she says. "For the first couple of months, you should not have any sun exposure on the treated area. A lot of times it may tan abnormally or slow the healing process. It's not permanent, but it can cause some blotching and can take several weeks or months to go away."

Here are some tips for sprucing up problem areas:

Spider veins. Spider veins on the legs and face typically will disappear after two to four laser treatments, says Alster. If it's just one little spider vein, it could cost up to $150 for each of two treatments. If there are several veins, the cost could rise to several hundred dollars.

However, says Arndt, electrosurgery -- an "electric needle" that applies a pinpoint of heat to the skin, shrinking and destroying blood vessels -- is also effective. "For spider veins, it works equally well.

Sun spots or "age spots." Sun spots, or what doctors call pigment problems, can be erased without a mark by the advanced lasers used today. In fact, a recent study in the journal Archives of Dermatology found that lasers were superior to liquid nitrogen, a freezing technique that "fades" the spots. One or two treatments may be necessary, at about $150 each. Expect some temporary blisters afterward.

Liquid nitrogen still has its place in some cases, Arndt maintains. "It's far less expensive [than lasers] and easy to apply. Cold seems to have more effect on pigment cells than other cells. ... It decreases or eliminates the extra pigment in the skin, and you often get a very good result. It may not be quite the same [as laser] but it's pretty good," he tells WebMD. However, Baumann adds, "Liquid nitrogen can leave white spots."

Birthmarks. Birthmarks -- like the signature port-wine stain of former Soviet premier Mikhail Gorbachev -- can be removed in eight to 10 laser treatments, depending on size, says Alster.

Tattoos. Tattoos are much more expensive to remove than to put on. Even small tattoos take numerous laser treatments, from four to 12. These laser treatments must be done two months apart -- or longer -- to give them enough time to heal.

Unwanted hair. Removing hair requires at least three laser treatments in succession, each one month apart. A woman's upper lip or chin can be $300 per treatment, possibly less with a package deal. For a larger area, like a woman's legs or a man's back, cost can be $1,000 per treatment. A maintenance schedule can be added, but the basic treatment series will eliminate 50% to 80% of the hair.

"For hair removal, lasers really do work well," says Baumann. "Most studies show lasers remove 30% of hair each treatment. The problem is, it takes about six treatments." And while results are better than electrolysis, getting rid of all the hair is difficult. "We now call it hair reduction instead of removal," she says. "If the hair grows back, it's thinner, lighter, and less dense."

Eflornithine Hal (Vaniqua) is a cream that slows hair growth. It's an especially great maintenance tool for those who have had laser treatments, Baumann tells WebMD. "Products like Nair burn the hair off. This actually affects the cells that make hair grow."

Facial lines and wrinkles. The problems that bother people the most, facial lines and wrinkles, can be treated several ways, says Alster. Three types of lasers are available today to tackle the whole range of wrinkle problems, from fine lines to deep wrinkles. The lasers burn off the top layer of the skin, and recovery generally takes about a week. With the carbon dioxide (CO2) laser, recovery may take nearly 10 days. A newer technology, the erbium:YAG laser, has substantially less downtime for recovery. Yet another laser that involves "dermal remodeling" puts heat on the dermis -- the outer skin layer -- "so you're basically tightening the tissue and causing new collagen to be created," says Alster. Cost can run about $1,500 to $2,000.

A trichloroacetic acid peel can often yield the same medium-depth results as an erbium laser treatment -- and is much cheaper, Baumann tells WebMD. "The peel runs only about $500 per treatment. But patients read magazines and they come in thinking they need lasers, when they can have the same great results with the peel. It's the same thing as with CO2 lasers and dermabrasion [a skin-sanding process]. They both have great results. But only a dermatologist can determine which is best for you."

For the beauty of your skin, there's yet one more advanced form of skin therapy, "intense pulse light therapy," says Seth Yellin, MD, assistant professor of dermatology at Emory University School of Medicine and chief of facial plastic surgery for Emory Health Care.

The therapy works by sending light energy through the outer skin, concentrating on the dermal layer just below. "Unlike any current therapy, be it chemical peeling, dermabrasion, or resurfacing with lasers -- all those attack the skin from the outside. This attacks the problem from the inside; it stimulates growth of collagen. So there is no visible damage, no healing that has to occur." He recommends six treatments, at a cost of about $2,000. A traditional full-face laser treatment, he says, would come close to $4,500.

Intense pulse-light therapy is not a laser treatment, Yellin tells WebMD. "Someone on the young side of the curve, from about age 40 to 45, who has fine to moderate level wrinkling, some pigment changes ... we can treat with this machine. It can treat superficial scarring and large pores. It can make pores smaller. ... Let me tell you, there's no other treatment for large pores."

When it comes to cosmetic surgery, the first rule of thumb is to head off problems early, when less intensive treatments are effective, Alster tells WebMD. "Most people won't realize you've been having treatments and you can maintain your youthful look longer. I'm seeing many more people in their early 30s."